EXCEPTIONAL CIRCUMSTANCES EXEMPTION REQUEST FORM

Requests for exemption to the Policies and Procedures of The CELBAN Centre must be made via this form only. Requests by telephone, email, or fax will not be accepted. The CELBAN Centre defines an exceptional circumstance as any unforeseen circumstance beyond the test taker’s control, which could reasonably affect the test taker’s ability to write the CELBAN (e.g. family emergency, illness, extreme weather). Human error on the part of the test taker is not grounds for an exceptional circumstance exemption. Before you complete this form, please review our Policies & Procedures.

If you would like to request an exemption to the Policies and Procedures of The CELBAN Centre, please complete and submit the form below.

Please attach all necessary supporting documentation (such as a doctor’s note – please ensure license number is included, next of kin death notice, letter from official, flight cancellation notice, etc.).

After submitting the form, you will receive an email confirming your request.

We will contact you again, after we have assessed your submission. Please allow up to 10 business days. To avoid delays, please submit the form only once and ensure all your information is correct.

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TEST LOCATION

TEST DATE

dd/mm/yyyy

Date and time

TEST TAKER INFORMATION

CELBAN ID (if available):

Given (First) Name:

Family (Last) Name:

Date of Birth:

dd/mm/yyyy

Date and time

Email:

Confirm Email:

TEST TAKER ADDRESS AND PHONE NUMBER

Street Number and Name:

City:

Province/Territory/State:

Country:

Postal Code:

Phone Number:

PLEASE DESCRIBE THE REASON FOR YOUR REQUEST

Statement of the nature of the circumstance:

PLEASE DESCRIBE THE EVIDENCE THAT YOU ARE PROVIDING
FOR YOUR CLAIM

A clear and concise description of documentation or references provided:

SUPPORTING DOCUMENTATION

Documentation providing evidence of the exceptional circumstance (such as a doctor’s note – please make sure license # is included; next of kin death notice; letter from official; flight cancellation notice, etc.)

Supporting documentation from a healthcare or counselling professional which indicates a diagnosis of mental health or physical illness that prevents the test taker from completing the test (healthcare or counselling professional must provide license # in documentation).

MS Word document, PDF, and graphic files are acceptable.

Upload file

Upload file

I testify that the information included on this form is accurate and truthful.